Meningococcemia

Picture of a Hand with Meningococcemia Rash

• Meningococcemia is a disease caused by the dissemination of Neisseria meningitidis into the bloodstream.
• There are three types of meningococcemia: meningitis caused by Neisseria meningitidis, meningitis with Neisseria meningitidis bacteremia, and meningococcemia (Neisseria meningitidis in the blood).
• The bacterial species, Neisseria meningitidis, causes meningococcemia.
• Meningococcemia is contagious person to person.
• The incubation period for the disease is about three to four days with the range of about two to 10 days.
• The contagious period starts during the incubation period lasts for about another seven to 14 days unless a carrier state develops.
• Symptoms and signs are the following for the meningitis type of meningococcemia:
  • Headache
  • Stiff neck
  • Fever
  • Nausea
  • Vomiting
  • Altered mental status
  • Sensitivity to light (photophobia)
• Symptoms and signs for meningococcemia are
  • fever,
  • fatigue,
  • weakness,
  • nausea,
  • vomiting,
  • diarrhea,
  • severe aches/pains in muscles, joints, chest and/or abdomen (enlarged spleen or swelling spleen),
  • chills, and
  • spotty rash that is purple; may vary in size (purpura, petechia, ecchymoses).
• Additional signs and symptoms for children may include
  • irritability,
  • slow reactions or inactivity,
  • poor feeding, and
  • vomiting.
• Specialists involved with treating meningococcemia may include emergency medicine, infectious disease, pediatricians, and critical care specialists.
• Physicians recommend rapid treatment with antibiotics (third-generation cephalosporins).
• Complications include septic shock, hypotension, altered mental status, gangrene, skin deterioration, and death.
• The prognosis for meningococcemia depends on early diagnosis and treatment. In general, the prognosis can range from good to poor, depending upon what complications, if any, develop.
• There are vaccines available to prevent infection by Neisseria meningitidis.

Meningococcemia is a disease caused by the dissemination of meningococci bacteria (Neisseria meningitidis) into the bloodstream. Meningococcal septicemia is another term for meningococcemia.

Photo of a 4-month-old infant with rash, lesions, and gangrene due to meningococcemia; photo courtesy of the CDC/Mr. Gust

There are three types of syndromes: meningitis (meningococcal meningitis caused by blood-borne Neisseria meningitidis), meningitis with Neisseria meningitidis bacteremia, and bacteremia with Neisseria meningitidis alone (meningococcemia). The main differences in types depend on the patient's symptoms and because there are symptoms that may be present in more than one type. The term meningococcemia covers all three types because initially they all start with Neisseria meningitidis infecting the blood. Please note that this article deals with meningitis caused by Neisseria meningitidis. There are many other types of meningitis.

Infection with Neisseria meningitidis is the cause of all three types of meningococcemia. The organism is a gram-negative diplococcus. There are at least 13 serogroups groups most important as being serogroups A, B, C, and W-135.

Meningococcemia is contagious person to person and spreads by close contact with the infected person (for example, direct contact like kissing).

The incubation period for meningococcemia is about three to four days with a range of about two to 10 days.

The contagious period for meningococcemia begins during the incubation period and lasts for another seven to 14 days. However, some patients may carry the bacteria on mucous membranes of the nose for example and have no signs of infection. These people can be contagious for long periods of time (weeks to months).

A major risk factor for this disease, especially among young adults, is living in close quarters under stressful situations. For example, outbreaks can occur among military recruits living in close quarters. A similar situation occurs in college dormitories. However, anyone living in crowded conditions are at increased risk for meningococcemia, especially serogroup B. Physicians more commonly diagnose the disease in teens and young adults and in patients who have compromised immune systems.

Meningococcal epidemics occur occasionally in developing areas like the Philippines and in many of the Central African countries. Before traveling to such countries, the CDC advises prophylaxis against meningococcemia.

Meningitis (meningococcal) occurs when Neisseria meningitidis spreads via the blood to the meninges (membranes protecting the brain). Common symptoms include

• headache,
• stiff neck,
• fever,
• nausea,
• vomiting,
• altered mental status, and
• sensitivity to light (photophobia).

Doctors usually see the above symptoms in adults, but in newborns and young children, some of the symptoms may be difficult to observe. However, the following symptoms in a child may occur:

• Irritability
• Slow reactions or inactivity
• Lethargy
• Poor feeding
• Vomiting

Symptoms and signs for meningococcemia (also termed meningococcal septicemia) are

• fever,
• fatigue,
• weakness,
• nausea,
• vomiting,
• diarrhea,
• severe aches/pains in muscles, joints, chest and/or abdomen (enlarged spleen or swelling spleen),
• chills, and
• spotty rash that is purple; may vary in size (purpura, petechia, ecchymoses)

Symptoms and signs for patients who have both meningitis and blood-borne Neisseria may have a combination of symptoms listed above. Rarely, medical professionals diagnose a chronic form of meningococcemia characterized by recurrent episodes of fever (fever that comes and goes), chills, night sweats, headache, anorexia, and associated with skin rash.

Specialists who assess and treat meningococcemia may include emergency medicine physicians, infectious disease specialists, pediatricians, and critical care specialists.

Usually, medical professionals make a diagnosis of meningococcemia from the patient's history and physical exam and usually is confirmed by culturing meningococci (Neisseria meningitidis) from blood, spinal fluid, joint fluid, and/or skin lesions.

Early antibiotic therapy may reduce mortality. Consequently, medical professionals should administer antibiotics intravenously or intramuscularly as soon as the diagnosis is suspected as the disease may be fulminant (aggressive, fast-moving). The intravenous route is preferred, as it may be more effective in patients with shock and/or poor tissue perfusion. Although penicillins (penicillin G, ampicillin) have been used in areas where susceptible bacterial strains exist, most physicians have found that third-generation cephalosporins such as cefuroxime, cefotaxime, and ceftriaxone are most effective. In addition, chloramphenicol, rifampin, minocycline, sulfadiazine, and ciprofloxin have been used in the past with mixed results.

Untreated, meningococcemia has a high mortality rate. Complications can be life threatening and include septic shock, hypotension, altered mental status, gangrene, skin deterioration, Waterhouse-Friderichsen syndrome (adrenal gland failure), and/or neurologic problems and death.

Even if treated early in the infection, the prognosis for the patient with meningococcemia is guarded. The prognosis declines rapidly the longer it takes to diagnose and treat the disease. In addition, if complications develop, the prognosis can decline further to poor.

Yes, there are meningococcal vaccines available to prevent infection by Neisseria meningitidis. Different vaccine versions (conjugate vaccines) are effective against all of the following types of meningococci: A, C, W-135, and Y. Another vaccine is effective against type B (serogroup B). The CDC recommends routine meningococcal conjugate vaccine for all preteens at 11 to 12 years old with a booster at age 16. Further recommendations include routine serogroup B meningococcal vaccination for people 10 years or older and others at increased risk for meningococcal disease (for example, college students).